Hypofractionated Versus Conventional Postmastectomy Radiotherapy in Implant-Based Breast Reconstruction: A Systematic Review and Meta-Analysis
In brief
Hypofractionated postmastectomy radiation reduces capsular contracture by about one-third
A meta-analysis of seven studies (2200 patients) found that hypofractionated PMRT lowered the odds of capsular contracture by roughly 35% and also cut wound dehiscence rates, while rates of implant removal and infection were unchanged. The evidence, drawn from two trials and five cohorts, supports moderate hypofractionation as a safe option, but higher-quality prospective data are still needed.
- Journal
- Journal of clinical medicine (Q1)
- Published
- 22 July 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Ji Hyeon Joo, Yongkan Ki, Youn-Joo Jung, Hyun Yul Kim, Ki Seok Choo, Kyung Jin Nam, et al.
- PMID
- 42513645
- DOI
- 10.3390/jcm15145732
Why clinicians should know about it
- Picked for Oncology and Radiation Oncology (top studies of the week, 2 August 2026): SR/MA of RCTs, hypofractionated vs conventional PMRT in implant reconstruction
Abstract
Background/Objectives: The safety of hypofractionated postmastectomy radiotherapy (HF-PMRT) in patients undergoing implant-based breast reconstruction remains uncertain because of concerns regarding radiation-related reconstructive complications. We conducted a systematic review and meta-analysis to compare reconstruction-related complications following HF-PMRT versus conventionally fractionated (CF) PMRT. Methods: PubMed, Cochrane Library, and EMBASE databases were searched through August 2025 following PRISMA guidelines. Studies comparing HF-PMRT with CF-PMRT in patients undergoing implant-based breast reconstruction were included. Outcomes were capsular contracture, implant or tissue expander removal, infection, and wound dehiscence. Risk of bias was assessed using RoB 2 and ROBINS-I tools. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using the Mantel-Haenszel method. Subgroup analyses were performed by reconstruction stage (tissue expander vs. permanent implant). Results: Seven studies (n = 2200 patients; 1153 HF, 1047 CF) were analyzed, comprising two randomized controlled trials and five retrospective cohort studies. HF-PMRT was associated with a significantly lower risk of capsular contracture (OR 0.65, 95% CI 0.47-0.92) and wound dehiscence (OR 0.39, 95% CI 0.16-0.94) than CF-PMRT. Implant or tissue expander removal (OR 0.90, 95% CI 0.67-1.22) or infection (OR 0.98, 95% CI 0.67-1.44) did not differ. In subgroup analyses, reduction in capsular contracture was most evident when PMRT was delivered during the tissue expansion phase. Conclusions: These findings suggest that moderate hypofractionation is a reasonable fractionation option for implant-based breast reconstruction, with no evidence of increased reconstructive complications, although the certainty of evidence was limited, and prospective validation is warranted.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.